Sea, Sun, and Scalpels: Brazil's Bid to Be the Four Seasons of Medical Tourism

Brazil, which has seen the number of foreign patients rise from 48,000 in 2005 to 180,000 last year—and is growing at a 30% clip year-over-year—is poised to draw still more from its neighbors and the U.S. thanks to shorter flights and a bump from futebol.

Brazilians endlessly repeat the old saw that the world thinks of only three things when it thinks of Brazil: samba, carnivale and football. But its healthcare industry would like to add a fourth—surgery. As part of Brazil’s efforts to leverage both the tourists and the infrastructure investments expected in the wake of the 2014 World Cup and 2016 Summer Olympics in Rio, the country hosted its first medical tourism conference last week in São Paulo.

One of the speakers was Ruben Toral, the former marketing director of Bangkok’s Bumrungrad International Hospital who I profiled in Fast Companytwo years ago. Since then, the number of medical tourists leaving the United States for heart- or hip- or brain surgery abroad has risen from 540,000 in 2008 to an estimated 878,000 this year. And that will practically double to 1.6 million in 2012, according to Deloitte’s projections. But earlier this year Congress threw a monkey wrench into Toral’s grand vision for the "Toyota-ization of healthcare," in which U.S. hospital groups would buy foreign ones and insurers like Aetna and United Health Group would offer patients discounts in exchange for outsourcing themselves and their bad knees overseas. It hasn’t happened, thanks to health care reform. Not because 47 million uninsured or underinsured Americans are suddenly covered, but because the legislation created so much complexity the insurance giants have curled into the fetal position.

Healthcare reform "sucked all of the oxygen out the industry's hopes that insurers would engage," Toral said Thursday during a break in the conference. "The un- and underinsured won't be coming anymore. Instead, you're going to see people with money leaving," the same kinds of people who have been fleeing the long waits in socialized medicine for decades. "You’re getting the Canadian system," in other words. "They’re better-informed medical travelers looking to meet their needs rather than head someplace that’s cheap. They're going to be leaving for service. The industry is in the midst of transforming itself."

One sign of that transformation is Lowe’s three-year deal with the Cleveland Clinic to cover employees’ heart surgeries, circumventing both local hospitals and the big insurers. According to USA Today last month, four other companies – including an airline and a bank – may soon follow suit. What the paper called "domestic medical travel" can cut employers’ costs by 20% to 40% — significant savings, but still only half the 70% or 80% discounts available overseas.

Which is where Brazil would like to come in. What separates its hospitals from their counterparts in Bangkok or Bangalore or Singapore is their world-famous reputation, albeit for plastic surgery. Surgeons such as Dr. Ivo Pitanguy—the "Michaelangelo of the scalpel" who invented many of the techniques—are justifiably famous overseas. "People don’t come to Brazil because it’s cheap; they come because it’s good!" said Mariana Palha, the conference organizer and CEO of Prime Medical Concierge, a Brazilian medical tourism company. "Brazil is known for its plastic surgery because it’s also known for its beaches."

But is that what Brazil wants to be known for? At times, panel discussions devolved into group therapy sessions for the BRIC member’s identity crisis: do we want to be seen as exotic or modern, as football and samba or sugarcane ethanol and Embraer jets? Do we strive for what we want, or leverage what we’ve got? "If plastic surgery is our cash cow, let’s use it," said the representative from Apex, Brazil’s export promotion agency. "What else? Heart surgery? Okay, what else?"

What else, indeed? "Orthopedics, opthamology, cardiology, neurology, fertility, oncology and dentistry," Palha listed, ticking off a list similar to international hospitals everywhere. Brazil’s can’t compete on price against India’s Apollo Hospitals or Bangkok General, and they don’t want to. Cornered at one point by Toral, demanding, "What do you want?" doctors from Sao Paulo’s prestigious Hospital Israelita Albert Einstein confessed they were only interested in promoting the hospital’s brand. Einstein was the first internationally accredited hospital in 1999, but the most famous by far is Bangkok’s Bumrungrad.

As The Finanical Times’ Tyler Brûlé recently pointed out, the next stage in the competition between the BRICs is who can build the first global brands. Brûlé gave Brazil the edge thanks to Havianas and bossa nova, but India has the lead when it comes to heart surgery. To succeed at medical tourism "you have to want it," said former Bumrungrad CEO Curt Schroeder, who started courting overseas patients in 1997-98 when the Asian Financial Crisis left his hospital’s beds empty; Brazil’s are currently full.

But sooner or later, Asia’s dominance of the market will end as Latin America’s economies rise, predicted Josef Woodman, author of the medical tourism manual Patients Beyond Borders. Brazil, which has seen the number of foreign patients rise from 48,000 in 2005 to 180,000 last year—and is growing at a 30% clip year-over-year—is poised to draw still more from its neighbors and the U.S. thanks to shorter flights and a bump from futebol. "The medicine is ready to go," promised Palha. "This is just the very beginning."